President Clinton kicked off an intense debate today on how to protect the privacy of medical records in an era when doctors can test their patients for genetic defects and send the information around the world with the click of a computer mouse.

In unveiling new rules to safeguard such information, Mr. Clinton said, "These standards represent an unprecedented step toward putting Americans back in control of their own medical records."

But doctors said the rules were inadequate and could actually erode some protections that patients now have. Several physician groups said they had been invited to today's White House ceremony, but stayed away because in many cases the proposal does not require that patients give consent before their records are shared, only that they be notified. Such a rule, they said, does not give patients enough control over the use and disclosure of their medical records.

"It is completely legal for someone to find out if a person has cancer, if the person is using drugs--or anything about you," said Amitai Etzioni, a George Washington University professor who recently published a book on the issue titled "The Limits of Privacy." "And indeed you can buy on the Internet for 400 dollars, more or less, anybody's medical records, with the exception of HIV," he said.

Existing privacy laws protect paper medical records. But this is not enough in this age of computers and global megamergers.

The Internet offers our corporate big brothers the means to electronically track the strongest, healthiest individuals in the running herd and the forceps to pluck out the sick people who are different and the weak. Governments are doing a little herding, too.

WE FEEL THE RIGHT TO PRIVACY IS IMPORTANT, BUT WE DO NOT PROTECT MEDICAL RECORDS SUFFICIENTLY

Privacy is so much a part of the American character that in its name the Supreme Court has even authorized mothers to take the lives of their unborn children. But not only records of abortions but other medical events and conditions - sometimes including embarrassing details that are discussed during medical examinations that traditionally have been left between patient and doctor - no longer may be protected from falling into the wrong hands, and even may be available for public scrutiny.

President Clinton established tough new rules Friday to protect the privacy of personal medical records that are stored electronically, but experts warn that dangerous gaps remain in patients' privacy.

Under Clinton's new executive order, doctors, hospitals and other health care providers may not release such personal medical information for purposes unrelated to treatment or payment without the patient's permission.

It also requires health plans to inform patients how the information was used and creates criminal and civil penalties for misusing medical information.

But the new order applies only to primary health-care providers, leaving pharmacists and most researchers unregulated. A patchwork of existing privacy laws already protect paper medical records.

MEDICAL INFORMATION HAS NO PROTECTION ONCE IT LEAVES THE DOCTORS OFFICE

"Right now, once information leaves a doctor's office, there are no federal regulations that protect the privacy of that information," says Goldman of Georgetown University.

Medical information routinely leaves doctors' offices: After a patient sees a doctor or fills a prescription, claims are sent to insurers and third-party bill collectors.

In turn, that information is sometimes given to drug companies or marketers. Insurers can "mine" prescription data, looking for patients with chronic health conditions such as asthma, diabetes or heart failure to enroll them in special programs .